Scientists endorse access to brain-boosting pills

Commentary calls for more research

NEW YORK 
Healthy people should have the right to boost their brains with pills, like those prescribed for hyperactive kids or memory-impaired older folks, several scientists contend in a provocative commentary.

College students are already illegally taking prescription stimulants such as Ritalin to help them study, and demand for such drugs is likely to grow elsewhere, scientists say.

“We should welcome new methods of improving our brain function,” and doing it with pills is no more morally objectionable than eating right or getting a good night's sleep, these experts wrote in an opinion piece published online yesterday by the journal Nature.

The commentary calls for more research and a variety of steps for managing the risks.

As more effective brain-boosting pills are developed, demand for them is likely to grow among middle-aged people who want youthful memory powers and multitasking workers who need to keep track of multiple demands, said one commentary author, brain scientist Martha Farah of the University of Pennsylvania.

“Almost everybody is going to want to use it,” Farah said.

“I would be the first in line if safe and effective drugs were developed that trumped caffeine,” another author, Michael Gazzaniga of the University of California Santa Barbara, said in an e-mail.

The seven authors, from the United States and Britain, include ethics experts and the editor in chief of Nature as well as scientists. They developed their case at a seminar funded by Nature and Rockefeller University in New York. Two authors said they consult for pharmaceutical companies; Farah said she had no such financial ties.

Some health experts agreed that the issue deserves attention. But the commentary didn't impress Leigh Turner of the University of Minnesota Center for Bioethics.

“It's a nice puff piece for selling medications for people who don't have an illness of any kind,” Turner said.

The commentary cites a 2001 survey of about 11,000 American college students that found 4 percent had used prescription stimulants illegally in the prior year. But at some colleges, the figure was as high as 25 percent.

“It's a felony, but it's being done,” Farah said.

The stimulants Adderall and Ritalin are prescribed mainly for people with attention deficit hyperactivity disorder, but they can help other people focus their attention and handle information in their heads, the commentary says.

Another drug called Provigil is approved for sleep disorders but is also prescribed for healthy people who need to stay alert when sleep-deprived, the commentary says. Lab studies show it can also perk up the brains of well-rested people. And some drugs developed for Alzheimer's disease also provide a modest memory boost, it says.

Ritalin is made by Switzerland-based Novartis, but the drug is also available generically. Adderall is made by U.K.-based Shire and Montvale, N.J.-based Barr Pharmaceuticals, and some formulations are also available generically. Provigil is made by Cephalon of Frazer, Pa.

While supporting the concept that healthy adults should be able to use brain-boosting drugs, the authors called for:

More research into the use, benefits and risks of such drugs. Much is unknown about the current medications, such as the risk of dependency when used for this purpose, the commentary said. Also, according to the Food and Drug Administration, Adderall, for example, is an amphetamine that carries warnings about possible sudden death, heart attack and stroke, especially for people with heart problems.

Policies to guard against people being coerced into taking them.

Steps to keep the benefits from making socioeconomic inequalities worse.

Action by doctors, educators and others to develop policies on the use of such drugs by healthy people.

Legislative action to allow drug companies to market the drugs to healthy people if they meet regulatory standards for safety and effectiveness.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, said she agreed with the commentary that the nonprescribed use of brain-boosting drugs must be studied.

But she said she was concerned that wider use of stimulants could lead more people to become addicted to them. That's what happened decades ago when they were widely prescribed for a variety of disorders, she said.

“Whether we like it or not, that property of stimulants is not going to go away,” she said.

Erik Parens, a senior research scholar at the Hastings Center, a bioethics think tank in Garrison, N.Y., said the commentary makes a convincing case that “we ought to be opening this up for public scrutiny and public conversation.”

One challenge will be finding ways to protect people against subtle coercion to use the drugs, the kind of thing parents feel when neighbor kids sign up for SAT prep courses, he said.

And if the nation moves to providing a basic package of health care to all its citizens, it's hard to see how it could afford to include brain-boosting drugs, Parens said. If they have to be bought separately, it raises the question about promoting societal inequalities, he said.